Wanted: NHS services and care homes as equal partners

Though difficult to develop, a culture of shared ownership between NHS services and care homes leads to numerous benefits as per a King’s Fund report, notes Alex Baylis

There is good evidence that proactively promoting the health of older people living in care homes, rather than just reacting to crises, can bring big benefits.

Areas that have taken this approach have generally seen unplanned hospital admissions from care homes fall by over 30 per cent; in some areas, these admissions have more than halved.

NHS England’s six vanguard schemes in care homes are raising awareness of the level of impact achieved by the enhanced health in care homes approach, and with an estimated 195,000 emergency admissions a year from care homes in England, there is clearly a big opportunity here.

While truly embedding the change in culture that joint working often needs can take a decade or more, this approach can start to yield results quickly

The exciting thing is that while truly embedding the change in culture that joint working often needs can take a decade or more, this approach can start to yield results quickly.

Our recent report on enhanced health in care homes shows that reductions in hospital admissions, falls and prescriptions (not to mention better experiences for residents, care home staff, GPs and community nurses) can often start within a few months.

What also stands out about the 15 areas highlighted in our report is how ordinary most of them are. They did not have any special or generous funding or have decades of experience of working together. And yet, they have been able to achieve impressive results, improving the quality of lives of residents and easing the pressure on NHS services.

If they can do it, then any area should be able to.

But if this approach has so much potential, why isn’t it happening in more places?

Challenges

The answer is that as impressive as the results can be, introducing it is not easy.

First, implementing the enhanced health care model is complex and there are gaps in the support available. For example, there is no guidance on the appropriateness of using public funds for training staff or developing information systems in independent sector care homes.

And while some resources are needed to develop this approach, there is no consensus about how much resource is needed initially. Ultimately, it is down to each area to collect information on costs and benefits and so work up a business case.

There is no consensus about how much resource is needed initially. It is down to each area to collect information on costs and benefits and work up a business case

A second challenge is measuring impact effectively. Even the best areas frequently measure impact only in terms of avoidance of NHS activity rather than in terms of residents’ quality of life. Though looking at quality of life is more difficult, doing so would reflect everyone’s priorities, and evidence shows this helps make it easier to sustain progress over time.

Third, at a time when both the NHS and care home sector are under huge pressure, it can be hard just to find the time for thinking about how to work differently.

Culture of shared ownership

Overcoming these obstacles requires leadership and effort at both service level and local system level and depends on building trusting relationships and shared commitment, something that cannot be easily lifted and shifted from one area to another in the same way as, say, a care pathway.

This focus on relationships is not just a question of those working in the NHS getting on well with their care home sector peers. The success of enhanced health depends on the NHS genuinely seeing those working in care homes as equal partners in ensuring the lives of care home residents are as long and healthy as possible – doing things “with” care homes rather than “to” them.

Overcoming these obstacles requires leadership and effort at both service level and local system level and depends on building trusting relationships

Building this kind of culture of shared ownership requires diplomacy and, frankly, sheer persistence. In some cases, it means fundamentally changing the way we think about those working in other sectors. These changes need to be both recognised and supported.

Those working in the NHS also need an in depth understanding of the care of frail older people.

It is true that enhanced health in care homes will probably never have as high a profile as other ambitious and often contentious plans to redraw boundaries between hospitals, community services and primary care.

Small steps big impact

The specific actions involved with enhanced health in care homes – like standardising training, so that district nurses are reassured that they can delegate tasks to care home staff – are often quite small in scale by comparison (though by no means easy).

But system leaders in all areas should consider the good news that these small scale changes usually do not require huge levels of extra resources and, with the right leadership and support, they can have a big impact.

Although embedding enhanced health on care homes is far from an easy option, the benefits are significant and so it is absolutely worth the effort. Above all, it offers some of the frailest and most vulnerable people in society the chance of better health and improved quality of life.

Alex BaylisAlex Baylis is assistant director of policy at The King’s Fund.